Counseling for Behavior Change
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This document outlines the steps for counseling patients to change behaviors: 1) Prepare by delivering a clear message and determining the patient's stage of change. 2) Help move the patient from contemplation to determination and action by building self-efficacy and creating an action plan. 3) Maintain the change through social support, addressing relapse as a learning experience, and ongoing follow up counseling matched to the patient's stage of change. The goal is to use brief counseling methods to help patients progress through the stages of change and overcome relapse in order to achieve long-term behavior modification.
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Counseling for Behavior Change
- 2. Objectives 1. Background 2. Counseling Steps 1. Preparation 2. Determination to Action 3. Maintaining Change
- 3. Background Cycle of Change Brief Intervention FRAMES Reflective Listening
- 4. Stages of Change Cycle Precontemplation Contemplation Determination Action Maintenance Relapse
- 5. Implications of Change Cycle Majority are NOT ready for action Each cycle improves the chance of maintenance of long-term change Counseling that is matched to stage enhances outcome Relapse is common and is a learning stage
- 6. Brief Intervention Features F Personalized Feedback to patient R Patient has Responsibility for change A Clear Advice on behavior to change M Menu of options for choice E Express Empathy to mobilize change S Evoke Self-efficacy to enhance confidence
- 8. Counseling Step # 1 : Preparation Delivering the Message Precontemplation Contemplation
- 10. The Message Counseling Give Personalized Feedback – Clear message, advice to change – Shutdown – Doctor babble Determine Readiness to Change (Stage) – Ask - “What do you KNOW about this?” – Ask - “How do you FEEL about this?” – Ask - “What are you willing to DO about this?”
- 11. Pre-Contemplation Clues Surprise Ignorance Demoralization
- 12. Pre-Contemplation Counseling Give information Patient education works Logbooks, journals, self-assessment Classes Role-models
- 13. Contemplation - Clues Ambivalence Emotional arousal Defensiveness Resistance Self-re-evaluation Values - behavior gap
- 14. Contemplation - Counseling Express Empathy Develop Discrepancy Avoid Argument Roll with Resistance Support Self-efficacy Use Decision Balance
- 15. Decision Balance Exercise No Change Change Old Behavior Like about? Worried about? New Behavior Worried about? Like about?
- 17. Counseling Step #2 : Determination to Action Determination Stage Self-Efficacy - Play Hard To Get Action Plan Action Plan Interview Action Stage
- 18. Determination Ephemeral stage Must do something about the problem Build Self-efficacy – Skills – Confidence of success – Conviction to act Develop plan for action
- 19. Determination Clues “This is a serious problem” “I must do something!” “I can make the change” NOT “What do you recommend I do?” NOT “Whatever you say I’ll do!”
- 20. Determination Counseling Play “hard to get” in telling what to do – “Only you know what is best for you. This is what others have used” – “I’m not sure you’re ready to act yet; convince me” – “How convinced are you change will help?” – “How confident are you you’re change will be successful?”
- 21. Plan for Action Realistic goal Small steps Short trial period (7 days) Self-monitoring Role-models Go public Plan for problems and lapses
- 22. Building an Action Plan Here is a MENU of options… What are you willing to DO? What or who might HELP? What PROBLEMS might arise? What will you DO until we next meet?
- 24. Action Patient makes changes alone Withdrawal symptoms – physical withdrawal – psychological withdrawal New coping behaviors Clues to act and avoid old habit Clues and rewards for new behavior
- 25. Action Counseling Moral support Log or journal Role-model Frequent contact Treat withdrawal symptoms Devise diversions
- 26. Counseling Step #3 Maintaining Change Maintenance Behavior Modification Social Support - Role-Models Relapse Learning Follow-up
- 27. Maintenance Clues Humility Humor Honesty Experience Success and failure Respect for conditions of relapse
- 28. Maintenance Counseling Self-monitoring Attend to cues and consequences of new and old behavior - act to form new habit Address maladaptive thoughts New coping strategies Use and become a role-model
- 29. Relapse Common, may be necessary Reframe as a learning experience Experience loss of control Learn pre-relapse clues Experience “relapse” thinking Cope with guilt and shame Cope with guilt and shame, “I blew it!”
- 30. Relapse Counseling Express empathy for guilt, shame, distress Confront “stinking thinking” Explore triggers to relapse Plan for different coping strategies Negotiate a new action plan Consider referral or increasing intensity of support Role-models Close follow-up
- 32. Summary Deliver a clear message about change Counsel by asking not telling Determine patient’s stage or change Use stage-specific counseling Use brief intervention methods Change involves more than knowledge Relapse is a usual stage of change
- 33. Source : • 2000, F. Duffy, D., MD, MACP and Goldstein, M.G.,MD, Counseling for Behavior Change, ACP